The Liz Moody Podcast - The REAL Science of Psychedelic Therapy: Microdosing, MDMA, Ketamine, Ayahuasca, and More

Episode Date: May 21, 2025

Do you think you might benefit from psychedelics, but have concerns about potential risks? In this conversation, I speak with Dr. Alexander Belser about psychedelics, from anecdotal benefits to the chemical breakdowns and reactions of psychedelic drugs. We discuss common drugs like psilocybin and MDMA to indigenous traditions around ayahuasca to lesser-known psychedelics like ibogaine.  Psychedelics are being studied for potential benefits for treating depression, PTSD, anxiety, and more. For the average person, do the benefits of taking psychedelics outweigh the risks? And how do you know which psychedelics are right for you? Alex and I discuss anecdotal experiences and research on psychedelics, and the behaviors that can reduce potential harms.  In this episode, we get into: What Are Psychedelics? Psilocybin (Shrooms), MDMA, Ketamine, LSD, & Ibogaine  Treating Addiction With Psychedelics  Ayahuasca and Appropriation From Indigenous Cultures The Science Behind Microdosing How To Safely Experiment With Psychedelics and If It’s Right For You For more from Dr. Alex Belser, find him on Instagram @alex.belser or online at https://alexbelser.com/. Check out his book, EMBARK Psychedelic Therapy for Depression: A New Approach for the Whole Person. Ready to uplevel every part of your life? Order Liz’s book 100 Ways to Change Your Life: The Science of Leveling Up Health, Happiness, Relationships & Success now!  To join The Liz Moody Podcast Club Facebook group, go to www.facebook.com/groups/thelizmoodypodcast. Connect with Liz on Instagram @lizmoody or online at www.lizmoody.com. Subscribe to the substack by visiting https://lizmoody.substack.com/welcome. Check out the previous episodes of The Liz Moody Podcast discussed today: Ask the Doctor: Anxiety Edition: Everything You Need to Know About Treating Anxiety Naturally with Ellen Vora, MD The New Science Of Depression & How To Actually Heal (+ SSRIs, Postpartum, Grief, and More) Check out some resources discussed in this episode: https://chacruna.net/ https://www.iceers.org/ayahuasca/  https://psychedelic.support/  This episode is sponsored by:AG1: visit drinkag1.com/lizmoody and get your FREE year supply of Vitamin D and 5 free travel packs today. The Liz Moody Podcast cover art by Zack. The Liz Moody Podcast music by Alex Ruimy. Formerly the Healthier Together Podcast.  This podcast and website represents the opinions of Liz Moody and her guests to the show. The content here should not be taken as medical advice. The content here is for information purposes only, and because each person is so unique, please consult your healthcare professional for any medical questions. The Liz Moody Podcast Episode 331. Learn more about your ad choices. Visit megaphone.fm/adchoices

A fear that I have around psychedelics, is there any danger in forming bad neural connections in addition to new good ones? I was an MDMA therapist for many years. And what we found, I'll just cut to the chase with the research, is that... Why hasn't there been pharmaceuticals that have come from these compounds? If they are so powerful, so many people are having these incredible results, why isn't this something you can go just ask your psychiatrist for? Microdosing. What are your thoughts on microdosing? What are your thoughts on microdosing? Is there anything you could articulate that you've learned?

learned about who we are or why we're here from all of these experiences that you've had. Hello, friends, and welcome back to the Liz Moody podcast. Today, we're diving into one of the most fascinating and rapidly evolving areas of mental health and wellness, psychedelics. These substances are everywhere in the cultural conversation right now, but what type? What's hope and what's actually backed by science? This episode is all about unpacking the complexities, the potential, and the very real risks of psychedelics. And I promise that you will walk away with a deeper understanding of how they work and whether they might be helpful for you or somebody that you love.

Our guest today is Dr. Alex Belser, a licensed psychologist and one of the foremost leaders in the psychedelic clinical community. For over 20 years, Alex has been at the forefront of research into how psychedelics can help treat some of the hardest to tackle mental health challenges. Think depression, anxiety, PTSD, OCD, addiction, and even end of life distress. He's authored over a dozen peer-reviewed journal articles and chapters and has given over 50 lectures, presentations, and grand rounds about psychedelic medicine. And he's currently conducting research at NYU and Yale. His work has been featured in The New York Times, The Atlantic, The New Yorker, and even Michael Pollan's iconic book, How to Change Your Mind.

In this episode, we're getting into the science of how all different types of psychedelics work, including MDMA, ayahuasca, psilocybin, ketamine, and more. we talk about their therapeutic potential, including couples therapy, how to navigate risks, the pros and cons of microdosing, practical tips for finding reputable facilitators, and what to consider if you or somebody you know is exploring the space, and so much more. If you have ever been curious about psychedelics or just want to understand what the conversation is all about, what's true, what's false, what the real science says, this episode is for you. And if you know somebody who's been Googling Psychedelics for Anxiety or how to Microdose, send them this episode. It could be really helpful as they begin to explore the journey. Alex, welcome with the podcast. Hi, Liz.

It's great to be here. I'm so excited to have you here. A lot of listeners have a lot of fears around psychedelics. So I'm hoping that we can clarify things. We can figure out how, if at all, we should be approaching these things. But I guess I'd want to start broad, which is what qualifies as a psychedelic? Like, what are we talking about here? This is a big, debate actually in the field, so it'd be nice if it were simple. Some people like to say, oh, this particular chain of chemical compounds is a classic hallucinogen or psychedelic. But the definition that I think most people find most helpful is to say that psychedelics are non-specific amplifiers of our conscious experience. It can amplify our feelings in our bodies, feelings in our heart,

our emotional state, our thoughts, our visual qualities. They can all sort of become bigger than they normally are in everyday waking consciousness. There's a lot of debate about this particular plant or this particular mushroom or this particular new compound. Is it truly psychedelic or not? So, for example, ketamine is one of the most popular psychedelics, but there's a big debate, is it an associative or a psychedelic? And so it comes down to oftentimes, you know, the individual's phenomenal inner experience rather than anything we can look at on the molecular chain and say, okay, that particular ring makes it a psychedelic. So there's nothing mechanism of action in your brain or body-wise that's happening that we're like,

okay, if this exact process happens, if this serotonin is released, if this chemical reaction cascade happens, that means it's a psychedelic. Yeah, the human brain is not quite such a Rube Goldberg device. It's more like a worldwide meteorological system with all sorts of rain and wind and things coming and going. So we can talk about the brain mechanisms a little bit because that might be really interesting, actually, to get into it. Would you like to do that? I would. Are they the same for psilocybin, MDMA? Are they different across different psychedelics?

They're different. So the classic serotonergic psychedelics, most people talk about them being active at the 5HT2A receptor site. If you look at something like psilocyne, which is the active ingredient in magic mushrooms, it looks almost exactly like serotonin. Most people wouldn't even distinguish it. It's just like one little bit different. Same thing with LSD. These are sort of DMT. These are some kind of classics. So they're active in the serotonergic system. really strong way, but they have multiple active sites at multiple 5HT and other receptor sites, for example. And so there's this huge race in the pharmaceutical development world amongst really nerdy and fun and, you know, brilliant chemists to come up with compounds that might be psychedelic that we haven't even dreamed of yet, for example. But other medicines like MDMA,

for example, is a phenethylamine, so it's different than the triptomines that I was describing earlier. So, for example, cacti, cacti are in the phenethymline class. They tend to last a little longer. So San Pedro, Piotte, sacrament, and the Native American Church, for example, that and a whole bunch of compounds by a guy named Dr. Alexander Shulgin, Zasha Shulgin, developed chusee B. These are sort of phenethylamine compounds. They have a slightly different quality. Sometimes they have a more heart-opening feel. They can be less visually trippy, or they can be as much visually trippy as others. And every single one of them has a slightly different signature or nuance. We had talked a little bit before about ibogaine and ketamine and

ayahuasca and a variety of, everything from like jimson weed, like things that can be the scopolamine context. These are different families that all have different unique mechanisms of action. They have unique personal signatures in our mind and our consciousness. And, you know, individual mileage will vary, right? Just in terms of the pure drug, and I'm not even talking about the context. the set and setting, whether it's psychotherapy or you're at a concert or you're in a profoundly and sacredly held spiritual tradition, right, a wisdom pet tradition. Why hasn't there been pharmaceuticals that have come from these compounds? If they are so powerful, so many people are having these incredible results, why isn't this something you can go just ask your psychiatrist for?

Well, they started actually as that. I mean, so MDMA, Ecstasy, Molly was developed by bare pharmaceuticals and over a century and 10 years ago, you know. It comes out of it comes out of a pharmacy. The chemist who synthesized LSD was doing basic research to help women who were giving birth not lose as much blood if there was a hemorrhage. And so the class of compounds that LSD 25 comes from is a class of compounds that were being tested by Sandoz Pharmaceuticals in Switzerland to help stop bleeding. So they were doing basic medical research and then they had these surprising qualities, even though there was a sort of cultural knowledge that like mushrooms could make UFC visions in the cassette since long before that. But because I think,

a 50 years of the drug war. And I think because in 1970, when Nixon signed the legislation controlled substances act and made it much more difficult to do basic research with psychedelic medicines, it's kind of been on cold storage for a long time. And what's the case now? There's been a huge resurgence. So I was part of a team. I started going to psychedelic conferences when I was still an undergraduate 25 years ago. And back then it was really a fringe movement. I mean, like, the only people that were involved are people who had had a personal conversion experience with psychedelics himself or involved some way in the underground or really in the sort of counterculture world. But since institutions like Hopkins and NYU and UCLA and nonprofits have done all of this phase two research, we're seeing a kind of slow regard for them increasing in the culture so that soccer moms can microdose and Titans in Silicon Valley can. can, you know, use this to come up with new ideas.

And there's portrayals of people going to ritual ayahuasca ceremonies on, you know, every cable miniseries, right? And so I don't mean to sort of trivialize any of that, but there's been a kind of a, the Overton window has opened pretty wide. And I think since Michael Pollan spoke how to change your mind, suddenly things which were taboo and forbidden and hidden, I mean, I even hid my research in part from my doctoral committee years ago. I didn't really really want to lead with that, that I was a psilocybin researcher for

many years. It's become something that you can talk about and people actually get excited to talk about at a cocktail party or, you know, when you're at your kid's soccer game. Like, did that help you? Well, like, tell me about it. I'm curious about it. That's led to a massive influx of capital because the government hasn't really been funding this up till now that led to kind of a boom and then in the last couple years a little bit more of a bust in the psychedelic world of drug development to try to get a medicine through the circuitous FDA approval channels. And the FDA, and the FDA has actually signaled that it's really willing and interested in approving these medicines. They've granted what they call BTD status, which is breakthrough therapy designation,

to five different psychedelic programs, putting them on a fast track for review and kind of giving them a leg up in terms of signaling that there seems to be a breakthrough therapy here. And that includes things like LSD treatment for anxiety. My former company, Sybin, did work for people who are already on SSRIs but are still depressed and treating them with an analog of psilocybin, the magic mushroom ingredient. And so that's really changed kind of a groundswell in the culture. We might see psychedelic medicines like MDMA and psilocybin and related medicines available more often,

not just ketamine, which is already like really quite out there in a lot of ways. Okay, so I'd love to do is just go through a list of psychedelics. And for each one, maybe you can tell me a little bit about the mechanism of action, like what's happening in our body, what's happening in our brain, and the benefits that have been shown in research around those things. And then maybe any unique risks that that particular compound poses. Okay. Okay. Let's start with psilocybin. Great. We've all heard about mushrooms, right? And I know that you're a chef and I'm sure have used all sorts of maybe less psychoactive mushrooms. I've worked in Amsterdam for a while.

Oh, did you know? And that was where I first had my experiences with non-chef mushrooms. Yeah. When I was in grad school in England, it was you couldn't have dried mushrooms, but they would sell mushrooms in psychedelic mushrooms, like in those sort of like bodega refrigerators. Yeah. In Amsterdam, when I was there at least, it was all fresh mushrooms.

Yeah. Yeah. So psilocybin was a sort of, of all the substances was the ones that the early researchers in our team and NYU and Hopkins and UCLA chose. They kind of avoided LSD because it had a lot of cold. cultural baggage and it's a longer compound, even though it was well known. But psilocybin, a lot of people don't even know what it was, except that maybe it's associated with mushrooms.

And what's interesting about psilocybin, and this is true for a lot of psychedelics, is that they work in so many different ways in our brain, which makes it a little complicated, a little heterogeneous to study. Like I said before, they're involved in the serotonergic system, but there's this debate, like, what is going on in the human brain, really? And what does it mean? Can we not, like, give somebody mushrooms and put them under, like an fMRI and watch Can science not figure this out?

Well, there have been active, like, live brain imaging studies. Okay. And what they find is that the different balkanized regions of the brain, which usually kind of do their own little regional thing, suddenly start talking to each other in interesting ways. So that's why we get things like synesthesia. So when I was in a trial, I'm working with a woman in NYU at Bellevue Hospital and First Avenue in New York City in Manhattan, you know, she was in a closed room, but she

had short sleeve shirts on. and she could see in her mind's eye like a beautiful cloud, like a white fluffy cloud full of vapor, and she could feel water vapor on her arm. And I was in the room. It wasn't any drier or more wet than any normal other time, but she had these synesthesia experiences of different things crossing. So that's really interesting,

and it might be related to this idea that psychedelics are neuroplastic adaptogens or neuroplastic agents that they help us relearn. So we all come up as people who have coping strategies, habits that become deeply ingrained, and we get really, really good at them. We specialize, we do this particular type of avoidance very well, or we're really good at this particular type of leaning in. But with psychedelics, because many of them promote BDNF, which is a compound that is

associated with neuroplasticity, new synaptic growth in the brain, new connections. When neurons fire together, they wire together over time. They may open a critical window so that we can unlearn previous habits that may or may not serve us anymore. They might be maladaptive today, even if they were adaptive years ago. And learn new habits, right? Like being less ruminative when you're depressed. Maybe we can be a little bit more have a relationship to the rumination. Like, I see that.

There it is going on. But I'm not in it as much, for example. Can I ask a question about that? Yeah. A fear that I have around psychedelics is that as we're opening up all these new neural connections, I won't just be breaking bad habits and forming good ones. I'll be forming other bad neural connections. Like, is there any danger in forming bad neural connections in addition to new good ones? Yes. Okay. The short answer I think is yes. It's a valid fear.

Which is one of the reasons why the phrase on everyone's lips over the last five years in particular has been integration. because the question is, well, if you put yourself into a habit where, and there's been people that have used psychedelics for many bad purposes in the past for exactly this reason. So, for example, the CIA used MK Ultra experiments to try to do mind control and give, because they could disperse LSD in a vaporized form to people and they did testing. And so did the Soviets, as far as we know. Psychedelics could potentially, and it's been argued, could, maybe they're not an intrinsically good thing. but they are something that can shift and be an opportunity for shifts. And so what's important is that we fortify that with our intention, the container, working with trusted and navigating with trusted people in some meaningful way,

and doing our inner work and maybe therapeutic work in the hours, days, weeks afterwards, so that we trade up instead of trading down. And if you do all of those things, can you pretty much guarantee you're going to have your brain go the good way, versus the not good way? Do we basically know how to control for this at this point? I don't think that we can control the variables. Okay.

Because we live in a world where we don't control the variables. Yeah. It's entirely possible that some bad could happen. What we see in the clinical trials is that on the whole, the results are quite astounding. So, for example, in our psilocybin trial, we're working with people who have, for example, cancer. This is one of the first major patient populations we're working with. And they have terrible distress about cancer, anxiety and depression and existential distress. And what we see it in multiple studies is that people to get really better, not just a little

bit better, but significantly better. So, for example, by better, you mean mentally? They report less anxiety. They report less depression or total remission from depression. They report in alcoholism trials with psilocybin here in New York with Dr. Michael Bogan shoots and others, you know, they report significantly fewer heavy drinking days. They report a significant remission of alcohol use disorder. And we see that that's not just like a small effect, but we call that a large magnitude effect for almost all of these trials. SSRIs, placebo effects, they tend to be small effects, something like 0.2 to 0.4. It's a statistical term. And it just means a statistic that says the standard deviation for most people gets this much better. But we're

looking at 0.8 to 1.8, which is multiples better for most psychedelic work. And it's not something you take every day. It's something that you do once, twice or three times and then seem to have some durable benefit that doesn't just happen immediately, quickly. Because when we give people psilocybin, they were better within an hour, like by the end of the session after the treatment. And when we measured the next day. And they were better three months out.

And even in long-term studies, they seemed to be better, even though we didn't have a comparator group, two and four years out. So if we're thinking about psilocybin, what should we be thinking about? anxiety, depression, what other kind of factors? It's also being, I mean, some people joke. Alcoholism, so addiction. The main things are addictions, including cocaine use disorder, opioid use disorder, crystal meth, phanamine abuse sort of stuff.

All of that is potentially being looked at. There's also some initial research on degenerative neurological disorders, which is not my area like Parkinson's, for example. juries out on that. The main things that have in study have been the big heavy hitters and the problems of psychiatry, which is anxiety, depression, PTSD. There's also some looking at eating disorder work. We noticed that some of our patients reported significant, I mean, they had significant decreases in their body weight. We weren't treating obesity or people who had higher body weights. A lot of people just sort of early on said, I lost 30 pounds over the

last six months because I'm happier and my life's different. I'm changing different habits. I also wonder if some of the addiction pathways are at work there because so many of us are addicted to food. Exactly. So some of the addiction to gambling and, you know, addictive drugs could be improved by exactly the sort of our emotional relationship with eating. That's interesting. Okay. Silicin, are there any unique risks to psilocybin that either are universal for all the things we're going to talk about or are specific to psilocybin? I don't think there's any unique risks. A lot of people

are growing their own psilocybin. It's not hard to grow. And they're not particularly hard to grow. So you just want to be kind of careful about that. The main risk that people talk about with psilocybin is just when people go mushroom hunting. You know, and that's like, that's not my thing. Because I can't really identify mushrooms appropriately in the wild.

Even when people say they can, I get so, so nervous about that. The neurodegenerative risk thing is really interesting to me because I think a fear that I heard from listeners a lot is, is this having some sort of long-term negative impact on my brain? And you're saying no, and it might actually be having a positive long-term impact. Right. I think it might catalyze change. We don't see a lot of long-term negative impacts.

I mean, I don't see any negative long-term impacts. The only risk that is not unique to psilocybin that I do think that people need to worry about and think about seriously is HPPD, which is called hallucinogen persisting perceptual disorder. And so some very small percentage of people have things like flashbacks, which can and do seem to happen in a very rare number of cases where unprompted at some later day, people will have like a re-experience. A re-experience like, oh, I'm on this drug again or of the trauma that they were working on while they're on the drug. Like it feels phenomenally like they're on the drug again. Okay. So colors might start like. Colors, lights, all the sort of sensory stuff, but also like a sort of inner feelings.

Oh, this feels like psilocybin again. Do we know what's happening there? We don't seem to know what's going on with that yet. But it seems rare enough and the flashbacks seems to be low enough that it's not, we haven't seen any of that in the clinical trials. This is more reported in the community. So it's not like we're running trials with hundreds or thousands of people and we see this very often. It seems to be quite a rarity.

And maybe there's something else going on that we're not, we don't know about. Are people working on trying to figure out what that is and how to deal with it? There's some work on that for sure, and I hope that there'll be some case studies published on it, but we just haven't really seen that in a controlled environment. We've seen it in the community. Have you seen it with anybody you've worked with? Yeah, I have. What do you do with your clients that have that?

You know, it depends on the person. Usually if they're relatively experienced with psychedelics, they're like, okay, I need to make sure I'm, like, you know, in a bedroom that I can close the door or in a safer place if they're out in the world. I mean, mainly you want to not be doing anything dangerous, like operating a car. Is the duration similar to what the duration of the original trip would have been? It seems like the duration is similar. It seems like oftentimes the dose is much feels less. Okay.

And so it's unclear exactly what's going on. Yeah. You know, it's not clear if there's some bit of the drug that's being reactivated in the body's system. It's not clear if there's some like intense rememory experience that's being reconstructed in some way. Does it concern you or do you have clients that come to you and they're like, I want to try this, but I'm concerned. I had a lot of listeners who were concerned about HPPD. Well, some people have the other experience with HPPD, which is that for some people, once you take a psychedelic, and this seems to be also like less than at least a couple of percentage points, you always see things a little bit differently after that. And that's what some people report.

And some people seem to like it. Like they see the world more richly or more colorfully. But like when they're looking at the table, they're not just saying, oh, that's a table. They're saying, oh, I'm seeing this table has brown planks and there's little modeled edges and this sort of has a life. and there's like a sort of feeling about it. And so there's like a richer experience, which can be disconcerting when you just want to like put something on the table.

So that's my experience. Now, I'm not an expert on HPPD, so I can't really speak to all of that. And there is a very active community around that that we want to look out for. And, you know, and the FDA is asking us to record everything that we see. So we'll definitely take a look at that. It's a pretty rare experience.

Like I only know one person who's ever had that experience personally. The rest of it are through friends or acquaintances. Yeah. And we're going to talk about microducing later. But moving on to next psychedelic MDMA, how should we be thinking about when MDMA might be appropriate? I love working with MDMA. I was an MDMA therapist for many years working on MAPS's trials. And we were treating people with severe PTSD.

And who had on average, they'd seen combat trauma. They'd experienced sexual violence. They'd been in like nearly fatal car crashes and were other people who might have died. And it had it for, on average. average 18 years. And what we found, I'll just cut to the chase with the research, is that when you're in a trauma loop, you know, you're kind of like, if you're going down like the wild river and then your raft kind of gets sucked into a gyre after a big boulder and you kind of, you can't, you can't jump out of it. That's like a trauma loop. And so the trauma narrative, you'd say, well, I was in combat and

then we got pinned down by fire. And then later on, this thing happened to me. But you never actually go into the experience. MDMA relieves the amygdala. response of extreme fear, which protects the psyche from re-experiencing the trauma. The psyche's like, we don't want to go there. We don't want to go there. With MDMA, with a supportive team, people oftentimes can intentionally navigate to that experience and then pop out of that gyre that's keeping them from breathing. And so unwind that sort of restrictive, repetitive trauma loop and have an actual metabolism of the experience that leads to fuller resolution and relief from PTSD symptoms, which really quite beautiful.

With MDMA, you were asking about the difficulties. You want to be careful in the community. Most people who are using psychedelics are using them in the community. They're using them in, I mean, I grew up in 90s rave culture. You know, I'm in the queer scene in the world. Like, there's a lot of people using lots of different drugs for lots of all sorts of reasons. With MDMA, it can be slightly habit-forming for some people that seems to be less of an issue, in part because the more you take it, the less effective it becomes.

You have to be careful with adulteration with MDMA, like with all. with all drug products, you'd be good to test and to make sure it doesn't have something else in it. Is there a way for the layman to do that? The biggest problem with the adulteration with most drugs right now is if there's fentanyl in them. And you can get a fentanyl test strip

and just put a tiny little bit of the drug with water and test whether it contains fentanyl. That's the main concern. It's not really that much of an issue with MDMA. Oftentimes it has a caffeine in it. Sometimes it has amphetamines in it. None of which is great, but it's It's not, that's not a real problem.

One of the main problems with MDMA is hypotremia, people are dancing for hours, and there's this big encouragement to drink lots and lots of water because people are getting dehydrated, which generally is a good idea. But some people, like, all public messages, some people are, like, there's an extreme, right?

Some people are like, they drinking, like, gallons of water and dancing, and their water level gets so high that their sodium level gets so low, they have hypotremia, which can be a very dangerous condition and they need to get salt into the body. Oh, interesting. So have your, electrolytes if you're going to hydrate well on MDMA.

That's right. I remember I did a lot of drugs when I was like in college in that time of my life. And when we did MDMA, I remember the day after I'd always just feel like the worst crash. Like I'd feel depressed, lethargic, way worse than a hangover. What was going on there? What time were you taking it? I mean, probably like in the middle of night, like 11 p.m.

So there's a sort of like if we were doing like a Instagram short, like Mythbuster, I don't think that suicide Tuesdays or like moody Mondays after MDMA is a real thing. What is that for anybody who's not familiar? So the idea, so what that means is that if you take the MDMA, Molly on a Saturday night and then you feel maybe me on Sunday, but then on Monday you go back to work and you're like miserable or that you have like a recurrence of like so like you just don't want to live. You have like really low enjoyment and you just feel out of it. That I think is a real thing.

The question is what causes that. And what we see in all over trials is we give people MDMA at 9 a.m. in the morning. By 5 p.m., they're done. They have a little bit of snacks and fruit. They go home, they journal, or they stay in the clinic and they journal, and they sort of chill out with their partner, and then they go to bed at a reasonable hour. They don't have a massive circadian disruption that keeps them up until the break of dawn, which is a heck of a lot of fun.

But a circadian disruption is pretty exhausting. Oftentimes people are mixing, not all the time, but oftentimes they're mixing it with alcohol or cigarettes or something. And then, so they miss an entire sleep cycle. And I think that that is part of the problem. The other thing that happens is what my colleague, Dr. Jessica Katzman, calls the therapeutic bends. Do you remember the bends, like if you're like a diver that goes down underneath a bridge? If you come up too quickly, it can be really dangerous. A lot of people have such a great time on NDMA that when they go back to work,

It's like reentering the death star. You know, it's just like, oh, I really, my life, they realize my life is really not structured in a way that it's going to be meaningful and make me happy. And so I had this glimpse of a life where I could be connected and feel better about myself and feel more physically vital. And like I imagined a life of work that felt meaningful to me. And I could kind of see it. But then the clouds came back and covered that up.

And now here I am at my desk doing this thing that I don't like. I don't feel respected. I'm in a relationship that's problematic. And so it can be quite of a headspin. To see a different world as being possible, it can be really motivating, but it can be dispiriting too when you reenter the life as it is.

The other thing I remember about MDMA is it made me want to love everybody. Like I just felt so close to everybody. Do they use it in couples therapy? It was used in the 70s in couples therapy. There were therapists that when they moved to schedule it, back then testified before Congress, like, don't take this medicine away from us. It's great for couples therapy. I don't give MDMA in couples therapy, but I've worked with couples who do take it.

And as part of my practice, I provide psychedelic support for them. You've had famous couples counselors on your show. Like, you know, what happens is that people get locked into communication patterns where there's a sort of mutual lock-in oftentimes. And, you know, with good couples counseling, people can unlock, but the MTMA, because of its amygdala response, helps people get out of their entrenched position. And it can really rev up, as you put it, your compassion and empathy and also the sort of like seeing through the eyes of your lover, right? Seeing the world as they see it. And even if you don't agree with all of it, you can see how it feels for them. And so that in profound empathic response, it can really melt the glacier of a frozen cold conflict relationship.

Oh, that's interesting. Okay, so MDMA, we have PTSD. It's really, really helpful for PTSD. It can be helpful for these relational issues as well. Is it as good as psilocybin for like anxiety, depression, things like that? The sort of like joke is like psychedelics are medicines in search of an indication, in search of a disease. psilocybin has been mainly studied for depression and anxiety, and right now depression.

MDMA has mainly been studied for PTSD, but the jury's still out about whether MDMA might be as effective for substance use or for depression or anxiety, for example. Because once a drug kind of gets in like a channel for that particular drug for that particular problem, it kind of just stays in that channel for years and years and years because of the way our drug development pipeline is set up. So it doesn't pay to like check it out for lots of other things. So there's kind of exploratory studies for other indications. But I think the idea that psilocybin is good for X and MDMA is good for Y and DMT is good for Z and ayahuasca's good for, you know, prime is a limitation to how we might think about it. How should we think about it then? Because we know the problems of our lives. We know how we want to feel better and we're looking at all these different options.

How should we begin to think about, well, should I try this? Should I try this? Yeah. If we're talking like legally, you know, right now the only thing that can be done legally is really ketamine work. And we could talk about that. I do think that it's very likely that within a matter of a few years, we're going to have legal psilocybin and psilocybin analogs and legal MDMA that could be used on label and maybe off label for a variety of things. In terms of us deciding in the sort of like rest of the world where people are using drugs for other purposes, you know, a lot of people do it based upon what they have access to. Some people feel called to a particular experience. Sometimes they work with a particular practitioner whose focuses on one thing.

I'm not sure any of those are like really great reasons to go with something instead of something else. Oftentimes people begin with MDMA because it tends to be a relatively more forgiving drug and can be less scary for people in terms of their inner experience. Don't discount MDMA. It is a very powerful medicine and can be quite scary. But people oftentimes begin there. They may move on to something like psilocybin. But the more esoteric compounds, I mean, I say esoteric, but less use compounds like 5MMO DMT or other things. Those compounds are really easy to take very high doses of. It's not so much to me a question of what medicine you take. It's more a question of what dosage you go at.

And people who go for heroic doses or high doses early on, I would caution you to be really thoughtful about that. It's much better to sort of take low dose in terms of a harm reduction and benefit maximization idea to take low doses with a trusted person or with somebody who is experienced, who's a facilitator that you trust and have, I oftentimes say people,

if you don't feel like you can cry in front of this person, you don't want to trip with this person. And then, you know, work up to, and within a context of a much deeper container, higher dose work. A lot of people think that psychedelics are like aspirin, I take two, or if it's really bad, I'll take four. Taking four hits of LSD is not the same as taking for ibuprofen.

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you do it one more time or something usually, but it seems inherent to the experience to take this really powerful dose. Yeah. That depends on the cultural context. So, for example, the Swar people are somewhat, I mean, I'm not an expert on their culture, but they're somewhat famous for giving pretty high doses of psilocybin. Where are they located? They're in South America.

I mean, a lot of Peruvian traditions also use very high doses of ayahuasca. But, you know, like in the Santo Dime, which is a big worldwide church. where people take ayahuasca, they don't always use super high doses. In fact, they use like sort of what I think of as like, you know, mesodoses, like middle range doses where they can do a lot of work and they're not completely bowled over by the experience and they can still dance and talk and work. They're not completely sort of inundated with the intensity of the feeling. You mentioned these things play a really big part in these indigenous cultures. Do you have any concerns about appropriation with people from the U.S. or other Western countries

going and having these experiences without maybe an understanding of the cultural background? Absolutely. I mean, I just got back from last year from a cultural exchange with a group of Shepibo practitioners. And the Shepipo people are known as a sort of doctoris. I mean, that's still a Spanish word, right? It's still a colonial world. But the doctors of the medicine of ayahuasca, they say, They've trained with it for generations, and they have a very strong guiding tradition with it,

and they sing in different ways, and they have their own language and tradition around it. And, you know, when you fly into certain cities and places like the Amazon bases in Brazil and Peru, like they've become like tourist trap with all of the problems of global, north-south, massive misalignment of power and money and cultural appropriation problems, including, you know, reverse incentives in the local community for people who aren't really deeply trained in ayahuasca to hang a shingle and say, come in, I'll give you in your friends ayahuasca this week. And for the ayahuascaros or the people who give the medicine, who get hired by resorts that are owned by wealthy white folks from Europe or the global north, to hire people.

who actually have deep training in the medicine, but they actually don't own the place, right? They're sort of hired out as contract workers and don't get as much of the income from the practice. And I don't think that's unique to medicine. I think that's true for any time you travel anywhere. And yet, there's something about psychedelics that really ask us to look into each other's eyes and say, how am I treating you? Not just like in this chat moment, but like, what is our relationship together? What is our power relation? What is it mean for me to be in this place with you, who's being paid, who owns what, what is the meaning of it? Am I taking from your tradition? What does that mean? And I don't think that that means that

we can't exchange wisdom. I mean, here in America and in the West, we have wisdom. I'm a psychotherapist. I think that psychotherapy is one of the West's great gifts to the world. I think it can be beautiful and transformative. And it doesn't exist in the same way in other cultures. And so there's mutual exchange possible, but we have to be aware of our position. And, you know, I also feel profound gratitude for people who have carried and held traditions that have otherwise been erased through colonialism that would have been a race or industrialization so that we can learn from them. But I think they have made clear in different ways that we should name and acknowledge the practices and not do what has happened so often, which is to take the thing and run.

So if somebody was interested in ayahuasca, first of all, what do you think of ayahuasca in general? Are there different risks there? Are there different benefits that we should be thinking about? And is there a proper way to approach it if we're coming from the Western world? I think this is true for many psychedelic medicines, but to approach it and the practices that surround it with reverence and humility and curiosity and maybe hope, right? If people, sometimes people are really like, I'm really not at a great place. I'm coming here because I want some help. I think that that's new's earnest and really. real. Look, ayahuasca is one of the most profound harriers of human consciousness. I remember when an older fellow that I met in 2004 at a psychedelic conference, I never heard about Iowa, so he started talking about it. And the way that he spoke about it just, it unlocks something in me that, like, this is something that he has the deepest respect for in some way. And I think part of it is that it's not just the ayahuasca. It's the entire vehicle of the cultural capsule. of the Ikoros or the songs, of the circle that holds the work, of the deep lineage of the

teaching that informs the entire thing. So it's not just a pill that you're going to get out of a dispensary and take, you know, in your living room. I don't think ayahuascus ever, are not likely soon going to be a FDA-approved medicine or EMA-approved medicine. First of all, it's two different psychoactive drugs, the vine, which is banisteriopsis capi, which has Harmaline and Harmalah alkaloids, which kind of give like a dreamy quality, but they are also M-A-O-I's. And so what they do is they take the other plant, which is psychotri of viridus, or it has DMT, N-N-D-M-T in it, which gives very beautiful visions oftentimes to people. But if you just eat it, it doesn't do anything. You actually have to either smoke it or if you combine it with

this other plant, the M-A-O-I allows it to become active in the gut. You have a journey over five to seven hours. And it's famous for making people purge, which can happen on other medicines, but particularly on ayahuasca, it happens a lot. And by that, you mean throwing up or pooping? Pooping, vomiting. Yeah. I think that here in the United States, we are scared to death of vomiting. It is like the worst thing.

People like really hate it. They don't like to do it. It doesn't feel good. Does not feel good. But the experience of that Upana, that sort of like throwing out of something. something is tied in profound and even primitive. I mean this in like a good way. Old, old, old patterns of psychosomatic trauma and learning. It goes to our earliest experience of swallowing, of vomiting when we're children. It goes to deep relational patterns. So it's not just

like a bad thing that happens like you stub your toe. It's associated with an entire, I mean, to use a different language, like an entire chakra lineage all the way from the second, the first chakra, all the way through the top of your head. And so the release that happens when you're not fighting the experience anymore and actually just like your body's like, we're giving up, it's coming out. Those cultures have revered La Purga,

the purge oftentimes, because it's not that you just want to vomit. Like, yes, I can understand that's deeply unpleasant, right? And we have a kind of taboo against it. It's something you do in private. Maybe don't even talk about. But it can open up

and has corollaries in the somatic experience, the emotional experience, the psychological experience, and the spiritual experience for many people. That's so interesting. So this thing that we might view as a negative side effect is actually inherent to the process, perhaps in a positive way. Sometimes people get a little nauseous on psilocybin or MDMA. We have an amnesus bowl in the room, a bowl, like a big bowl. And I tell them ahead of time, I was like, I call this bulwark. Like, you might feel like a little like dry heaving or like you almost, you're like you're holding on to something that's stuck and you might kind of

kind of like spit it up. So put the bowl in your lap and like do the bowlwork. Like whatever's coming up. Even if you don't vomit, a lot of people hold themselves. I'm using my sort of my thirst, like right in my solar plexus, like right in the throat, like in the abdomen area, just kind of like hold things down. And that resistance, the cultural resistance, which we're taught, like both keeps this functional in the world that doesn't want to see vomit, but also keeps us guarded in

a way from a type of vulnerability and softness that may allow for a different experience. If somebody's considering going to one of these countries where ayahuasca is more readily available and having one of these experiences, are there any questions that they should be asking themselves or ways to know if this is right for them? Yeah, I think that a couple of organizations like Chakruna and ICERS, have put out some guides about like navigating ethical use of ayahuasca. And I think that there are better and good ways to do that. Have you done ayahuasca? I have taken ayahuasca. What was your personal experience? How did you feel changed after?

I've been practicing with ayahuasca for 20 years. And I usually take it about every three to six months. And I always practice in an intentional setting with people who are skilled. You know, for me, this is like, psychedelics are not mainly about mental health benefit. And I'm a psychologist. I love mental health benefit. Don't get me wrong.

But they were about trying to understand what it's all about. Like, like, I mean, really, like, what are we doing here? Who are we? Who am I? What is the world coming to? Is there something more than this? If there is a God, where is she? Where, what's it like?

And I was, you know, I was like a closeted gay kid growing up in the 90s in Indiana. Like, this is not a fun place to be. I had a lot of, I had a lot of my own trauma and baggage, fear, rage. feeling of aloneness. And ayahuasca helped me really see all of that. It didn't take it away, but it really helped me see all of that in a way that I was able to kind of take the different pieces of myself and feel like I could kind of cohere them together into a morphal person. And this question of what is consciousness, what is it that I am experiencing, became, have you ever talked to like a philosophy major in college?

It can be one of the most like boring experiences because it's so cerebral. With ayahuasca for me, those questions became real, very real, like very embodied. They had like consequences about like what's how do I live a good life. They no longer became theoretical exercises and hypotheses. And I feel incredibly grateful to that. It has given me a well of spiritual meaning to draw from in times of darkness. And I think has opened my heart to working with other people in a different way that I think I would have been able to without it. Do you work with the other compounds regularly as well, psilocybin, MDMA, things like that?

I do have experiences with those, yeah. So I have my own firsthand experience, yeah. Could you kind of say in brief what your firsthand experience, how you felt changed by, let's say, psilocybin or MDMA? Like, what do you feel like those added to your life? You know, different people develop a relationship with each medicine. Sometimes people talk about the spirit of the medicine, if that's the way that you think about things. I think it's almost like entering into like a new topography or terrain.

Like it's like different biomes or something. It has a different signature. So psilocybin had, for me, a very visually rich signature. And it also felt very organically alive. And there's sort of like little mythos about each medicine, right? Like Maria Sabina talks about the little ones. Mazatech shamanists who brought in many important ways psilocybin into Western American consciousness. It can be seen as a little gentler than other compounds like LSD.

I will say with psilocybin, people, if you take enough of it, it is truly like a eschatologically shattering experience, meaning everything that you thought comprised the world as we know it might be different at the end of the day. It's not for the faint of heart. And I think that's true of any higher dose secondary experience, really. Is there anything you could articulate that you've learned about who we are

or why we're here from all of these experiences that you've had? Most of what we care about is BS. Tell me more. At least most of what I have cared about. You know, all the things that people organize your life around, whether it's getting that little status symbol,

that Gold Star, that A, or that job or that post or making partner, or the fantasy of Prince Charming coming down the road or, you know, all of the hassles of a day, none of that seems in any meaningful way, like actually a thing that's going to make any difference in the deep, deep way for me. So what's going to make a difference? I think psychedelics, because they are nonspecific amplifiers,

you don't have to do it this way, but it kind of forces you if you keep doing them to do what people call shadow work, to look at your own BS. it can be true that people managed to avoid that for years but I don't know how to be a person in the world without really looking at what I'm saying even as I'm talking right now to you especially as I'm talking right now

what is motivating that in a deep way do I want to look like a smart person on a podcast what is the deeper message of what I'm really talking about am I afraid of looking like a lunatic because I'm talking about my trans-personal experiences on a public venue. I mean, all of that, all of that is happening for me. But my ability to kind of see some of it

and has transformed how I can treat people, how I can work with my own patience. To really be with somebody means really having to be with yourself. And I think that a lot of people are still working on that. Have you made any pragmatic shifts in your day-to-day life? Like you do this thing differently every day

or you exited this relationship or something like that as a result of your experiences? Yeah, I took up meditation and been on many. I mean, I think that psychedelics also were like really motivating to try other things. I became a yoga teacher and a hatha, you couldn't lead a yoga teacher. I took up Zen. I became a psychotherapist. I really started reorienting my life around community rather than consumerism,

like watching a TV show or picking, you know, buying tickets to an event. Like I was like, how can I live in triangles and circles with other people? that structure of a design of a life is more meaningful to me. Yeah. Ketamine. Oh, yeah. What is that doing to our bodies, to our brains? What are some unique benefits that have been studied? I'm sure there's a lot more research on ketamine because it is legal and are there any unique risks? Ketamine is kind of like the red-headed stepchild of the psychedelic world. Okay.

A lot of people in the psychedelic world movement are really big fans of organic substances like plants and mushrooms and ketamine is a molecule that was developed by Park Davis in the 1970s. A lot of people in the psychedelic movement are big fans of like illegal drugs because they're into cognitive liberty and our anti-drug war. And ketamine has this kind of sideways history where it's kind of been the purview of illegal medical establishment, which for good and for bad has, you know, and not only medical establishment, but anesthesiology. Anesthesiologists have done a lot of great, great work with ketamine. In fact, a lot of the cottage industry and ketamine clinics that have sprung up in the last 15 years is a lot of anesthesiologists

that realized that they could help people with depression by doing the NIMH infusion protocol of 0.5 milligrams of ketamine per kilogram of human body weight over 40 minutes, which is not a psychedelic dose, but it's like a low dose that has shown to be having to have some good antidepressant qualities for people. But those are not psychosocial interventions usually. Like, you know, you get in a chair, you get the infusion. It's just like the, you just get the drug. And so a lot of people are disappointed with that. You know, ketamine, it's different than from the other psychedelics. At high doses, it's a wonder drug in terms of keeping people safe. It's still on the WHO's list of essential medicines in the world. It's still the most widely used human anesthetic. It tends to be

less visionary. Sometimes with silics, cybin or LSD, people talk about, like, getting like, almost like into the molecular matter at the micro level of the world and, like, really seeing their own heart issues, like in a very intense close-up way. Sometimes people describe ketamine as like star medicine. It's more like vast and cosmic. You oftentimes feel good on it. Like there's just like a mild, good feeling. And it also has the quality of disequilibering your vestibular system.

So it's a little hard to walk on it, for example. And at higher doses, you want to lie down and close the eyes. Otherwise, you might get a little nauseous even. But internally, it's called it dissociative because sometimes people have experiences of like kind of flying around or burrowing or channeling or tunneling, kind of like moving through rooms, even if they're completely still on the ground or the couch. It has mainly been studied for depression, but it seems when people take it, they have anxiolitic or anti-anxiety benefits. And it's also been studied for PTSD. All of this is off-label because

it's kind of an orphan drug. There's not really any profit motive in studying ketamine because ketamine is as cheap as water. You can give a bottle of Tasani for a lesson you can get, you know, at retail, at a sort of standard price, a bottle of ketamine if you have the, you know, if you get it through a legal channel. What do you think about the at-home ketamine that is now available? It is like both the best and worse of capitalist medicine in America. I think a lot of good happens. So like outfits like mind bloom and joyous and prescribers that prescribe at home, you know, generally it's safe that people can use ketamine at home. The main risk is drowning. Drowning? People take ketamine and they go into the bathtub and then they start to fall under the water.

Oh. And this is how if there are ketamine deaths, it's almost very often drowning related for the very low number of deaths that are associated with that. So lock yourself out of the bathroom? Uncontrolled setting. They do not get in water. Okay. This is a good rule for most drugs, by the way. But do you have some urge to get in? water when you're on ketamine? No. Okay, it just happens to happen and you're looking for the comfort of a bath or something like that. It seems to be the case. Interesting. Okay, so stay away from, but other than that, like, if somebody wanted to explore, are you like, that's, that's a reasonable way to do so? So for those outfits, oftentimes they have, like, a supervising, these are like often venture

capital-backed firms that have a supervising physician or a psychiatrist, and then they have psych-n-p's and that are licensed in different states to do a medical evaluation with you. And while the published research has showed that this can be helpful to many, many people, the level of care in my anecdotal experience is sense to be a little bit lackluster. There's not a lot of handholding. There's not a lot of close attention. There's a lot of making sure that we chart everything properly, but otherwise, like, you're kind of on your own.

It's not a relational drug. It's just like take the ketamine out and just put in your mouth and you can do your own intentional work, and they encourage you to do that usually. But there's not like a lot of preparation necessarily or a lot of integration. There are sometimes options for that, but it's like not really baked into the basic protocol for most people. And so what happens is you just get like drug and an experience, but it may not translate into some of, you don't really necessarily harness some of the catalytic benefits that you might get from ketamine. So I think that's problematic. The other thing that's problematic is a lot of them have a protocol that you take ketamine every day. So the other thing to

think about with ketamine is that it can be habit-forming. It is not nearly as habit-forming as opioids, nicotine, alcohol, benzos. But some people do notice that they start to have problematic usage habits, that they start to rely on it. They take it more often, and they find themselves wanting to take it, because it makes them feel better for a period of time. Luckily, it's not neurotoxic and there's not like a hangover effect, so it seems to have less problematic like in terms of impact and function of people's lives and some other drugs, but we need to be careful about that. We want to make sure that people aren't using ketamine in a bad way. And then you mentioned anxiety, depression. Do those results tend to be sticky after the usage

of the ketamine, the decrease in anxiety, the helpfulness with depression? What we're noticing initially with drugs like psilocybin and MDMA is in a super well-thought-out intensive relational treatment, people tend to have robust benefit for three months, six months, maybe a year. With ketamine, it tends to be more in a matter of weeks. And so oftentimes people will adopt treatment patterns where they take like a large dose or a few smaller doses of ketamine like once a month. It's kind of like a reset. For people who are suicidal, and ketamine is great. And there have been a lot of, we did, we did a, I was not a part of this, but my colleagues who did a study at NYU, Neu, and what we see is people come in to the ER and they're really, really down,

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I'd never heard of this. actually listeners asked me to ask you about this because I was like, tell me what this is, where does this come from? Did this not exist in my days where I was experimenting with these things? Yeah, it didn't. Okay. I mean, not in the same way. So Ivegain, what I know of it and what I've learned of it, and I've not worked with this medicine personally. But Ibegain has an indigenous history in Northern Africa with the fang and Bwitty people. And it's kind of a root and it

is considered a very powerful medicine. What it has besides initiation rights in those cultures, what it has garnered the most interest in, people have described it as being kind of a miracle for people that are in opioid withdrawal. So people who

have been taking heroin or morphine every day for a long time and they don't want to go through the withdrawal that causes flu-like symptoms. They can be treated with ibogaine, and it kind of does a reset of their craving system for opioids, and iBegaine is not usually a pleasant experience, so people are less likely to use it recreationally. But it's been studied for that, and a lot of people in the underground will go and, like, work with somebody who gives Ibogaine, like in a hotel for a day or two.

It does cause a lot of cardiovascular difficulties, like heart rates, so you have to actively monitor for that, even more so than you would with MDMA psilocybin. It's also unique in its pharmacokinetic profiles and pharmacodynamic profiles, which is like how it interacts in the human body. It's not a clean drug in the sense, clean, it doesn't mean it's a dirty drug, but we use this idea in chemistry. My sense is that it doesn't just have one side of action. It has probably over 20 psychoactive metabolites, the whole set of like complex things that are happening that might account for its action. and so because of the difficulty with like some potential cardiovascular risks and because of the you know the length of the period of time is a very long-acting drug it's probably again not going

to see a lot of pharmacy development unless they can isolate the thing that might just be particularly helpful for that yeah well because i'm like we the opioid crisis is begging for something like this so it's it's i imagine it's tempting to try to isolate whatever's going on there And a lot of people have said exactly that. Like, this is the time. I mean, in the last seven years, I think almost every year, more people have died from the opioid crisis every year than died during the height of the plague years of HIV AIDS.

Oh, I didn't know that. It is killing a lot of people. Yeah. And it doesn't have to be that way. And people are hooked on opioids. Ibogaine and Amboga could be a potential help for that. But we live in a very risk-averse culture. which is that on the whole, this could be really good,

and it should, I think, be studied. And it costs, you know, hundreds of millions of dollars to bring a drug to market, especially one like this. And, you know, you don't, if it has cardiovascular risk, it might be a real tough cell. Do other ones of these psychedelics have cardiovascular risks as well? Most of the drugs I've talked about cause transient increases in hypertension. I mean, I'm not a physician, by the way.

So I don't have medical training, but they do cause increases in your blood pressure. and heart rate. And so we often monitor for that to make sure that if somebody has like uncontrolled hypertension, they might not be a good candidate for this. They have some some heart issues. You definitely want to speak with a trusted physician. But you said transient. So this is something that goes back to normal when the drug clears your system. Yeah, because it's exciting and maybe a little scary and kind of like beautiful. And so so your blood, your heart rate is also stimulating. You're getting all this input, right? The internal input or visual input. So yeah, yeah, it goes up for a period of time. And then it goes down by the end of this session.

LSD. What is happening there to our brains, to our bodies? What are people experiencing in terms of results? And are there any unique risks with that? Well, LSD is a sort of like countercultural, archetypal, 1968 Summer of Love, sash, like 1970s, like what meant wrong? Story of the American latter half of the 20th century. And not just America, right?

Yeah, are people in the psychedelics community, like, mad at LSD? because so much research would have happened, if not for kind of what happened in the 60s and 70s? There's still an active fight about, like, who's to blame? That's interesting. Do we blame Leary and Metzner? And, like, the research could off the rails. And if they got more serious, this is the argument that's often made.

If they kept it serious and didn't let the genie out of the bottle, we might all have good psychedelic legal treatments, you know, in our local clinic. Interesting. LSD is, what does I say about LSD? I don't think that for most people, it's that. big a difference from psilocybin in terms of experience and the visual aesthetic and sort of what happens during the experience. It is, it does last longer and it can be, I think, by advanced in terms of like really experienced users can be discerned, but I don't, I think a lot of people

wouldn't be able to distinguish them, you know, for the first few times they were taking them, which one they might have gotten if they were, if they were blinded, for example, to it. But it has all of this cultural baggage. You need so little of it. You only need a hundred, a standard dose of LSD, like you might get 100 micrograms. So we're not talking grams or milligrams. No, the three orders of magnitude, smaller micrograms, so that you can transport it easily, which is one of the problems, you know,

from an interdiction perspective, which is really hard to find LSD, if you're searching for it, which also just means you can put it on sugar cubes or stamps or under your tongue or things, you can put it in all sorts of things. It's not really being studied that much except by a company called MindMed

that is looking at LSD for the treatment of generalized anxiety disorder. And they're looking at slightly higher doses, I think up to 200 micrograms, which is kind of like a double dose in some circles, with like a kind of like a basic support model, like not psychotherapy, but just like a basic safety model. It invokes and provokes a lot of like fear and apprehension and concern. Because at higher doses, it's really easy to take a lot of it. Like with mushrooms, you just have to eat more and more and more.

But with LSD, it's like very easy to take four drops of something, for example. I have a friend in college who took mushrooms and had what I can only call like a mental break and seemed like they never fully recovered from that. And I feel like I occasionally come across these stories in my life. What is happening there? And is there any way to prevent that sort of outcome? Yeah. This is maybe the most, the thing we didn't get to earlier, which we probably should really talk about, which is that in almost all of the clinical trials, we are excluding people who have any history of what we call thought disorder. or a first-degree relative with schizophrenia.

Because it's not that psychedelics might not be actually helpful for that, but there's this concern that they may catalyze a thought disorder process and a person who's predisposed to it, either genetically or biologically or in terms of a developmental experience, for example, like adverse childhood experiences with like a family history. So we don't really know what it looks like. And so your friend who had this terrifying experience and might not have really ever been the same sense, it's really scary to hear that.

And sad to, it's sad to hear that. What's happening is that what we see, and this is true a little bit of cannabis, is that people who might be predisposed to a psychotic break, which might happen, like a manifestation of sort of thought to sort of like hearing voices that other people don't hear, seeing things that other people don't see, tends to happen in people's 20s anyway. and taking psychedelics may kind of open that up a little faster than otherwise would have happened. That's not necessarily proven, but there seems to be some case evidence for exactly that. I think that this is going to be one of the things that the agency, the FDA and others should be concerned about,

which is like, what do we do with people who might have a predisposition to a schizophrenic process? How do we know, outside of having a first-degree relative, you said? Yeah. So first-degree relatives are a really good indicator. These might not be a good choice for you. But other than that, how do we know? And you also said in your 20s, this is naturally when these things show up. I remember when I was like cleared 25. I was like, who like I made it through. Oh, okay. Like I did. You were like chicken the clock. Yeah, kind of. I was aware of it. My dad's psychologist, my mom's psychologist. I had it in the back of my mind. And it was a thought of my 25th birthday. So if we're in our 30s, are we more in the clear of these risk factors? What should we be thinking about here?

I would say you're certainly more in the clear if you're already in your 30s or 40s or 50s are being. But I think it's all a calculated risk. I don't think there's going to be a completely safe way to do it. It's the same thing that's true for manic episodes, for example. Sometimes psychedelics can, if you have a history of mania, might spur a manic episode just because it's dysregulating for a short period of time. And so it might spur a process that was otherwise latent. And that could be really scary.

That being said, psychedelics are being looked at as a treatment for bipolar disorder mania and as a treatment for a psychotic thought process, actually, to resolve a psychotic thought process is sort of stuck in a maladaptive pattern of thinking, right? Like paranoia, for example. But those interventions will require like a lot of bootstrap, more preparation, more support from a psychotherapy team, more integration, more thoughtful dosing, maybe lower dosing, for example, is what I mean. So I think the jury's still out.

If somebody's risk adverse, but they hear about all these benefits, they're like, I struggle with depression, I struggle with anxiety, I really want to have some of these benefits. Are there better psychedelics or ones that are more risk-free or better ways to approach it? What's the most risk-adverse way to begin to engage with some of these benefits? Well, when you look at harms, most psychedelics cause fewer physiological harms than any other drug class. They're just like the Lancet, there was a review, for example. They're really not harmful drugs. We're talking a lot about the risks of psychedelics today. We just don't see that many of this coming up in a lot of the clinical trials.

But I do think the biggest thing you can do is to go slow. Don't jump into the deep end with a high dose. Take lower doses. And if you have something come up for you, then that's a better time to attend to it than going into the deep end of the pool and taking a higher dose. Do you have any advice for finding? a good practitioner to do this type of thing with? It's kind of a problem because we live in a time of prohibition. So everyone that I would refer people to is like working outside of a legal,

psychotherapeutic or medical model. What I tell people that come to me as I say, you know, a lot of people choose to go abroad because they can go to places like Holland or Costa Rica or Peru and maybe have legal experiences. If you're working alone, I think the best thing to do, is basic harm reduction stuff. If you're working with an underground practitioner, navigate potential harms,

which is like talk to references if they'll let you do that, get to know them well, get a second person to come and meet them potentially to get a second feeling about it. You know, some people know if they're a really good read of people, and some people are not such a good read of people. Like some people are really good at saying

something not quite right about this particular interaction, and I think maybe this is not a good fit for me. You have to be aware, I encourage you to be aware if you're feeling desperate. That is very much a sign that this is maybe not the best. You're maybe not acting with as much clarity of thought as you want to be, which is like, this is my last hope. I need the psychedelic to work.

That's when the alarm bells start to go off from me because it can be really disturbing if it doesn't work, right? Psychedelics, even when they work really well are in a panacea, they don't fix everything. I do think that people who have psychotherapeutic licensure tend to be, I mean, there's a lot of therapists that are not great out there, but they have better experience talking with people. I think working with somebody who can talk about their own experience,

like that they have an experience or they can talk about how much background they have in this. Have they been doing this for a week? Or have they worked with five people or 50 people or what? What kind of training do they get? All those sort of basic things that you would want to know. And it might be good to do like a dry run with them for a few hours or to do something with them that's sort of like not like a drug,

like breathwork or something that, gets you a little bit of your body, just does a trial run to see if you like working with them? Or try telling them a secret and see how it feels. Oh, I love that. That's like a fun little. Yeah. Well, you mentioned all these clinical trials, too. Is there a way that we can find out about those and get in them? Getting in a clinical trial is like winning the medical lottery for a psychedelic trial.

Usually clinical trial is chased down people and pay the money to be in a trial. We're finding that getting into a clinical trial is really, really hard. So I almost entirely discourage people from trying that. Okay. There is a site where, I mean, first of all, clinical trials.gov lists all the trials, and you can search for your indication and drug. And they'll list hundreds of psychedelic trials and whether they're recruiting or not. And I think psychedelic. Support, which is a community resource, has a list of like,

so you want to be in a clinical trial. Here's like who's recruiting. But for most people, there's so many inclusion and exclusion criteria or timing problems that most people are probably not going to get into most trials. Okay. No, who did? Microdocene. What are your thoughts on microdosing? What are your thoughts on microdosing?

So I was trying to look into the research and the anecdotal response seems to be robust. People report feeling creativity, increased, decreased anxiety, improved depression, all of these things. The Reddit threads are profound. But I couldn't find that much data in terms of clinical research showing these same effects. And so I was trying to square those two things in my mind when I was researching this. What if I told you I'd give you a magic hat. And if you wore the hat on the days that you were, you would feel better. Oh, I'd love that.

The hat really works. You should try it. It's a magic hat. See those little stars and like a lightning bolt and a crescent moon on the top. Are you telling me it's all placebo? No, I think it is largely placebo, maybe all placebo. and placebo is the most beautiful and powerful effect in medicine that we have. If we could get placebo to work to full placebo effect every time,

then we would be a much better place. And psychedelics are super placebo's. People believe they will work, and then they take them at very low, very low doses that are probably sub-threshold. And then they, by gosh, by golly, they feel better. Look, I'm a huge fan of microdosing because I think it's one of these practices that has almost no negative effect for most people, because you're taking a very low dose.

If you're really microdosing, which is one-tenth of a standard dose, you're not even having threshold effects. Like, you shouldn't notice something off in your visual field. You shouldn't feel anything in particular. That's the whole point of microdosing, is it's below the threshold of noticing.

And when we do citizen science, in any randomized control trial, where people are actually blinded, it doesn't differentiate from placebo. But it's a really strong and robust placebo effect. And guess what? A 0.4 Cohen's D, which is a placebo effect,

is literally the average placebo. effect of lexapro. And, you know, like, so we're talking about an effect that is approved for other studies. So it's, it's actually comparable, potentially. And what I find interesting about placebo is even being told in my understanding that something is placebo doesn't make it less effective. So somebody listening to this podcast and being told that shouldn't make the impact less from my understanding. No, I, I hope not. I hope I'm not like popping any bubbles for anybody. I mean, I really mean that. It's also just a powerful practice to say, I'm going to do this thing. I would take this pill. And my intention is to be happier, more self-loving, more creative, less anxious, less ruminative today. Forget about yesterday

and forget about tomorrow, but just for today for the next eight hours. Let's see how this works. That is a powerful self-fulfilling prophecy for many people. What are your thoughts on doing it every day? Is there a amount we should stop at? You do a week on, a week off. The main protocols for microdosing from people like Fatim and Stamets do not advocate every day. And I really, this is not my area of specialization, but I would refer you to a little article online called Can MDMA Break Your Heart by a pharmacologist named Keelan Thomas, K-E-L-A-N. The basic ideas I understand it is that they usually do like a one day on two or three day off or some sort of variance on that, which just gives the body time to re-regulate.

If you take most psychedelics like a serotonergic like psilocybin every day, it could potentially be a problem for cardiac valvulopathy, which is that it's not just active at the 5HT2A receptor, which is what is associated with mood and visions, but also like a 5HT2B receptor, which is associated with some cardiac valvulopathy problems. So you don't want to do it every single day. Now, we don't have a lot of data on that. And as far as we can tell, there are many, many hundreds of thousands, at least people microdosing and very few cardiac vivalopathy reports, but better be on the safe side and

do it and on again, off again kind of thing. And then you've talked about how in research these psychedelics are showing these profound effects that are much larger than we can get from SSRIs or SNRIs. can you microdose or take hero's doses when you're on SSRIs or SNRIs? The short answer is yes and, but maybe some thoughts to consider. So I used to be the chief clinical officer at Saibin, and Saibin, one of the work that we were doing there that they're continuing is looking at exactly this problem.

If you're treating depression, most people who are getting treated for depression are already on some sort of medication. So then asking them to go off of the medication gives you all of those tapering and discontinuation symptoms that Dr. Ellen Horrow was talking about previously on your show and then you have to restart it again afterward. And if you want to take the psychedelic again,

you have to do the whole thing again and you have all of these relapse and potential discontinuation problems. What if we just took the SSRI and then took psilocybin or, you know, in the case of Sybin, CYB-0-03, which is a psilocybin analog, why not just take it with the

SSRI. And what they do in those trials is they actually just skip the dose the morning of, of your common SSRI or SNRI, so that rather than skipping three days or a week or two weeks and having a full washout, they just skip the morning dose and you take that morning dose later in the day afterward. The basic effect for most SSRIs, this is not true for MAOIs, by the way, but for most SSRIs, MAIs are potentially dangerous because they could extend the life of several dogs. What would that drug be, like an MIOI? What would we know the name? These are like a 1970s style antidepressants. Like very, very few people are on them at this point.

But there are people that have MAIs. For most SSRIs, they are mitigators. So what this means is that you'll go out with five friends and four of them aren't unnecessorized and you're on an SSRI and you take the same dose of medicine and everyone else has like a full trip and you have like a half trip. They mitigate the effect. You would need to take more to have a similar effect.

So they sort of dial down the experience for most people, which is not necessarily a problem, but it does become a problem in terms of risk. mitigation because then you have to adopt a booster strategy. For example, if you want to have the same level of therapeutic effect, meaning, well, I'm not exactly sure how much of a mitigation effect. Is it 10%, is it 30%, is it 50%. So I'm going to take what I think will work, and then I'm going to take a booster an hour and a half later, if I'm not quite up to par. And, you know, this kind of works. And so there's a lot of like questions. But what we have found is that it looks like that can be done safely and thoughtfully. It's

just a question of you might need a little bit more of the psychedelic to arrive at the same in the same zone of effect that your compatriots would. And then you mentioned we don't want to take baths when we're taking these things, but set and setting are important. Can you explain for somebody who's engaging with these things at home what would be an ideal setting or environment to be in? Yeah, absolutely. The ideal environment is different for every person and every moment. So there's not like a perfect place. But I'm going to talk about this in a slightly different way. It's possible that psychedelics make you hyper suggestible. You're just super suggestible to anything that comes in, super sensitive, almost like a baby. It's just like really sensitive to anything

that might happen, which could be really great or really bad. So if you're in an environment that has been prepared with love, it's clean, and you've gone through and gotten rid of all your stuff, and you've put up a pot of beautiful flowers, and you've prepared some mango for eating later. You've done your morning meditation, and you've resolved your fights with your friends that week, and you're like in a fine place with work and in your major relationships,

and it's infused with love of you and the other people that you're there with, and there's a deep intention, and there's like a sharing circle, and you've done your yoga. I mean, you've done all the things that you think you can to create a depth of safety and container together.

I mean relationally, including just like knowing what, you know, not doing this in like a busy intersection, right? Like the little child, like that love becomes amplified, that good feeling and intention becomes amplified. And you come out of it with the better set and setting that becomes amplified. The problem that we see is that people think in a lot of concerts, for example, like jam-bin concerts are often designed to be set and setting for people tripping. The Grateful Dead and Fish were kind of explicit about that in some important ways. But the problem is like the sonic experience is really quite beautiful. But like if you have to go to the bathroom and then your friend lost their phone and then like somebody next to you elbowed you and then you're like, I took too much.

And suddenly you have to lie down like on a staircase somewhere. Like that is non-optimal set in setting. And so it might work for 90% of the audience, but a significant percentage have difficult time because there's no comfy bed. And there's no like windows we can close. if it gets too noisy or too hot or whatever it might be. So controlled is probably a big part of this. You want to put yourself in a situation where as much of it is in your control as possible. Well, there are people that would advocate that it's good to try not to be overly controlled.

People advocate that to me in my life all the time. I'm hearing that might be like one of those like growth edges for you. And for me too to some extent. Like a lot of people love to trip in nature. And I know people that really do that. I think it's good to make sure you know how to get to an ER if you just need to. Just do the planning too. And being outside of nature can be really beautiful.

People are really an advocate for transforming our experience of the natural world. It's not just a tree. It's like a living being and you can maybe experience that in a different way. Trying to control the vertical and the horizontal in every last potential variable is probably going to lead to a overtly defensive psychological structure that says I just need it to be a particular way. And that resistance structure, bad trips usually come, in my experience,

when we resist what's happening too much, when we fight against it and, like, barricade in and, like, keep up sword and shield up. That's why people keep on saying you need to learn how to surrender. And can therapists help with that if you're doing it in a session with a therapist? It can help, especially if somebody's binding the store,

if you really believe that your therapist is going to look out for your heart and your physical safety, and answer the door, if somebody knocks or rings the doorbell, even that level of safety, like, I trust this person, they're not going to hurt me, they're going to help other people. Wow, that opens up so much psychic energy for me to work on other stuff. But if you're there alone, and then the phone rings,

or the male person comes to the door, or like, I don't know, your mom drops by with your birthday gift, like, that's not great. Yeah. If you don't want to take psychedelics, but you want to mimic the effects as much as you possibly can. What would you recommend? I think that as human beings, it is in our primary birthright to have access to non-ordinary consciousness,

altered, expanded states of awareness. And there are ways to do that in multiple lineages that aren't just taking psychedelics. The human breath can bring us there. Holotropic breathwork, shamanic breathwork with a train facilitator. For many people, just breathe, heavily with driving music using the sort of work of Hell and Bonnie that use music to help

evoke a different state, you don't have to take a pill or a profound drug. You can do this intense breathwork and see what it's like to get out of your head. A lot of people do things like kundalini or esoteric yogic practices that can then bring on fast state changes in the human mind. Go from like a logi, dysthymic state to like a feeling of clarity or equilibrium. You know, there are other practices that are a little, like, edgier. Well, like, like sexual tantric practices, white tantra, red tantra, black tantra, BDSM practices. There are ways to do those more safely and lovingly and meaningfully that can be, that can bring people out of everyday awareness. Does breathwork have the same impacts on your brain?

Does it have a similar mechanism of action to any of the actual things that are happening when you take psychedelics? Yeah. As far as I'm, I know, we don't really know, because there haven't been a lot of good brain imaging live studies on breathworks. I'm not exactly sure what's going to be different in the brain, but that level of oxygenation, and we see this from Wim Hof and other people that are big advocates for this. You know, this doesn't work for everybody. A lot of people say, like, I didn't really have like that huge of an experience, but we run holotropic or other like shamanic breathworks and all of our clinical trainings for psychedelic therapists, because we can't

really give them medicine legally because it's not, it's a hard way to, hard way to do that. But We think that it's important that if they're going to lead a person and facilitate with a person through a non-ordinary state of consciousness, that that therapist, that clinician, should also have had their own non-ordinary state of consciousness. And we use breathwork in a collective setting to build a team feeling, but also to give people an experience to get out of their everyday mind. So you guys believe that it's powerful enough in terms of being able to access that different state that you're using it in this clinical setting. Yeah. For some people, for many people, it can be profoundly visionary. And even more meaningful and more important than like a very strong MDMA or psilocybin trip. Okay.

The person who's listening to this episode is either interested in experimenting with psychedelics or they have tried it. They're just, they're trying to explore this world. Are there any final thoughts that you would have for somebody whose interest has been piqued by psychedelics? But there may be unsure. They're maybe feeling a little bit nervous. What would you say to them? Are there any other myths that you'd like to bust? If you're feeling unsure or ambivalent, I think ambivalence is the hallmark of being a neurotic person in the world.

We don't really know what's going to be good for us, but we hope that something that we do will be wise and meaningful and important. And so I think this is why people are talking to each other about psychedelics, is that we actually trust one another. We can read all of the meta-analic reviews in the world, but if like your trusted friends says, no, this might be really be good for you. I know you and I know that I know what this might be. And I think it's really important that we talk about that. I don't see the psychedelic model as being, you know, the new class of psychiatrists in the hills is like, you know, sending prescriptions to people.

These are things that we do together. And that, I think, is the only way that we're going to do this and make it really beautiful and not dystopic or disheartening. If you're feeling ambivalent, like I would really honor the ambivalence. I'm not here to advocate that you should take psychedelic. And in fact, I know many people that have waited decades to take psychedelics because they're doing, they're like, I think I have other work to do first. And I'm not looking for a shortcut. They have, they have like stuff to do. It's therapy or couples counseling or they want to work on a physical

practice that's meaningful to them. So their vitality is higher. You know, like that only sets you up for for better work later on. Awesome. Well, thank you so much. Alex. This was so informative. And I really appreciate your time. Liz, it's been great being here. Thanks for having me. That is unfortunately all for this episode of the Liz Moody podcast. We all have that friend who is super interested in psychedelics. Make sure that you send them this episode so they can cut through all of the confusion and misinformation that is on the internet.

Just take a second right now and copy paste that link and send it to them. If you are not already following the Liz Moody podcast on Apple Podcasts on Spotify or on YouTube, make sure that you hit that follow button. That way new episodes will always show up right in your feed and you will never miss one. It is also the best way to support the podcast. It is so appreciated. And also remember, you can now watch full video episodes on Spotify and YouTube too. So if you're watching, hello, we're able to bring you this show completely free thanks to the amazing brands that we partner with. If you are looking for science-backed products to elevate your life, you can find

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taking your time and spending it this way with me and I will see you next time on the Liz Moody podcast. Oh, just one more thing. It's the legal language. This podcast is presented solely for educational and entertainment purposes. It is not intended as a substitute for the advice of a physician, a psychotherapist, or any other qualified professional.